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Illinois rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $0.94 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.82 / $0.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $2.58 / $10.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.64 / $0.80 / $0.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.12 / $8.50
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.12 / $2.20